Shoulder Arthritis

What is it?

• Shoulder arthritis is a painful condition caused by damage to the cartilage that lines the moving parts of your shoulder joint

Why might I have it?

• Healthy joint cartilage is an incredibly good joint surface
• Unfortunately, our joint cartilage gradually deteriorates as we get older so some of us get arthritis as our joint ‘wears out’
• Complete failure of your rotator cuff muscles (small muscles deep in the shoulder) can disrupt the motion of your shoulder’s ball and socket and accelerate a type of arthritis, called ‘cuff-tear-arthropathy’
• Inflammatory conditions (e.g. Rheumatoid arthritis) can also destroy the cartilage in your joints
• Injuries, such as broken bones and dislocations, may damage your joint surfaces and cause early arthritis 

Figure 1 Two patterns of shoulder arthritis. Osteoarthritis on the left, Rotator Cuff Arthropathy on the right (note the humeral head is not centred in the socket in the right hand image)

What are the symptoms of shoulder arthritis?

• Gradual onset of activity-related pain, which deteriorates to a constant dull pain, with severe exacerbations
• The pain often interrupts your sleep
• Global stiffness in your shoulder with a feeling of grating 
• The pattern of your shoulder movement may change (you may start to hitch your shoulder blade to move your arm)

What non-surgical treatments are there for shoulder arthritis?

• Rest, activity modification, painkillers and anti-inflammatories
• Physiotherapy 
  • Helps to maintain your range of motion and compensate for a problem shoulder by strengthening muscles around the shoulder girdle and in your trunk
• Cortisone (Steroid) injection 
  • This can have good effect, but it does not cure the arthritis
  • The duration of benefit is variable, but typically lasts 3-6 months

Will it get worse if I leave it?

• Widespread cartilage damage does not get better
• Patients usually experience a gradual decline in their pain control and function
• Your shoulder will continue to wear and you may develop bone loss as your joint continues to rub, which could complicate a future joint replacement

What Surgery can be done for Shoulder Arthritis?

In general, surgery is required once non-operative efforts have failed to control your symptoms. Your best option will depend on you and your pattern and severity of arthritis 

• Joint preservation
  • Comprehensive Arthroscopic Management (CAM)
• Joint replacement
  • Partial joint replacement (just the head is replaced
  • Total Shoulder Replacement (head and socket replaced)
  • Reverse Geometry Total Shoulder Replacement (both replaced, but ball and socket switched)

What is my Prognosis?

• Shoulder arthritis tends to progress slowly if left untreated.
• The keyhole ‘CAM’ procedure can improve symptoms and postpone the need for joint replacement surgery for a while in young active patients, but is not suitable for everyone.
• Modern shoulder replacements last a long time, but no joint replacement is as good as a healthy native shoulder.
• A good outcome for a replaced shoulder is a pain-free joint that allows you to perform normal daily activities.  It will rarely deliver completely full range of motion and power to your shoulder.
• As for other joint replacements, shoulder replacement carries risks of complications and it is important you understand these before having surgery.
• Overall, 80% of patients will be happy with their outcome, but a few patients will report ongoing niggles in their shoulder. It is rare (<5%) for patients to report no benefit, or worsening of their symptoms after surgery.
• Partial replacement (where only ball is replaced, but the socket is left alone) works well in many patients and is a quicker operation with slightly fewer complications, but modern data suggests better outcomes with total replacement (where both the ball and socket surfaces are replaced).
• Total shoulder replacement is very likely (90%) to last you at least ten years and, for many, it will last much longer.

Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.